Upon finding a school-age child having a seizure, what should be the nurse’s first action after lowering the client to the floor?

Turn the client to a lateral position.

Administer an anticonvulsant medication.

Apply oxygen by nasal cannula.

Check the client’s oxygen saturation.

Answer and Explanation

The Correct Answer is A

Choice A rationale
The first action a nurse should take upon finding a school-age child having a seizure is to ease the person to the floor and turn the person gently onto one side. This will help the person breathe and can prevent injury.
Choice B rationale
Administering an anticonvulsant medication is not the immediate first action a nurse should take upon finding a child having a seizure. The first priority is to ensure the child’s safety by easing them to the floor and turning them onto their side.
Choice C rationale
Applying oxygen by nasal cannula is not the immediate first action a nurse should take upon finding a child having a seizure. The first priority is to ensure the child’s safety by easing them to the floor and turning them onto their side.
Choice D rationale
Checking the client’s oxygen saturation is not the immediate first action a nurse should take upon finding a child having a seizure. The first priority is to ensure the child’s safety by easing them to the floor and turning them onto their side.

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Correct Answer is B

Explanation

The correct answer is choice B: Instruct the parent to avoid pressing on the abdominal area.

Rationale for each choice:

Choice A: Schedule the child for an abdominal ultrasound. While an ultrasound may be necessary for further diagnosis, it is not the immediate priority. The child’s symptoms suggest a possible Wilms’ tumor, a type of kidney cancer that primarily affects children. An ultrasound can help confirm this diagnosis, but it should not be the first action.
Choice B: Instruct the parent to avoid pressing on the abdominal area. This is the correct answer. If the child has a Wilms’ tumor, pressing on the abdominal area could potentially cause the cancer to spread. Therefore, it is crucial to avoid any unnecessary pressure on the abdomen until further medical evaluation can be performed.
Choice C: Determine if the child is having pain. While assessing for pain is an important part of nursing care, it is not the immediate priority in this situation. The child’s symptoms need urgent medical attention, and assessing for pain will not provide the necessary information to guide immediate care.
Choice D: Obtain a urine specimen for a urinalysis. Although a urinalysis can provide valuable information about a patient’s health, it is not the immediate priority in this situation. The child’s symptoms suggest a possible Wilms’ tumor, which requires immediate medical attention. A urinalysis may be part of the diagnostic process, but it should not be the first action taken.

A. “I will test my blood sugar before meals and at bedtime.”. B. “I should not take my regular insulin when I am sick.”. C. “I will rotate injection sites within my abdominal area.”. D. “I should eat a snack before I play soccer.”.

Correct Answer is B

Explanation

Choice A rationale
Regular blood sugar testing is crucial for managing type 1 diabetes. It helps the child and their caregivers monitor the child’s blood sugar levels and make necessary adjustments to their insulin doses or diet.
Choice B rationale
This statement indicates a need for additional teaching. Even when sick, it’s important for individuals with type 1 diabetes to continue taking their insulin. Illness often causes blood sugar levels to rise, so insulin is still needed.
Choice C rationale
Rotating injection sites can help prevent skin problems, such as lipodystrophy (a lump under the skin caused by the accumulation of extra fat at the site of many subcutaneous injections of insulin). Therefore, this is a correct practice.
Choice D rationale
Physical activity can lower blood sugar levels. Eating a snack before physical activities like playing soccer can help prevent hypoglycemia (low blood sugar). This is a correct understanding of managing physical activity with type 1 diabetes.

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Upon finding a school-age child having a seizure, what should be the nurse’s first action after lowering the client to the floor?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a toddler whose parent states that the child has a mass in his abdominal area and his urine is a pink color. Which of the following actions is the nurse’s priority?

Correct Answer is B

Explanation

A nurse is providing teaching to a school-age child who has a new diagnosis of type 1 diabetes mellitus. Which of the following statements by the child indicates a need for additional teaching?

Correct Answer is B

Explanation

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